Provider Demographics
NPI:1346128535
Name:ODOR, ISIEOMA RAY
Entity type:Individual
Prefix:
First Name:ISIEOMA
Middle Name:RAY
Last Name:ODOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 EMERSON AVE S UNIT 507
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-1051
Mailing Address - Country:US
Mailing Address - Phone:952-486-3369
Mailing Address - Fax:
Practice Address - Street 1:1206 42ND AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-1611
Practice Address - Country:US
Practice Address - Phone:612-824-3369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist